Rapid Immune Test Cuts HIV Care Drop-Outs

Action Points

Explain that a point-of-care test -- which provides results showing the number of CD4-positive T cells within a few minutes -- sharply cut the proportion of people who dropped out of HIV care before starting treatment and reduced the chances that people would be lost to follow-up.

Note that use of the test also nearly doubled the proportion of patients starting anti-retroviral therapy.

By eliminating bottlenecks, a rapid immune system test sharply cut the proportion of people who dropped out of HIV care before starting treatment, researchers reported.

And the point-of-care test -- which provides results showing the number of CD4-positive T cells within a few minutes -- also nearly doubled the proportion of patients starting anti-retroviral therapy, according to Ilesh Jani, MD, of the Instituto Nacional de Sáude in Maputo, Mozambique, and colleagues.

The use of the test in four clinics in Mozambique allowed speedier staging of HIV-positive patients and reduced the chances people would be lost to follow-up, Jani and colleagues reported online in The Lancet.

In the long run, they concluded, such tests might mean patients would start therapy at a higher CD4 cell count, with reduced risk of HIV-related mortality.

The gold standard method to measure CD4 cell counts is by flow cytometry, but many resource-poor countries don't have the infrastructure, skilled technicians, or money to allow convenient CD4 cell testing. The World Health Organization has been promoting the new rapid tests, three of which are being developed.

Jani and colleagues noted that the previous practice in the four clinics was to bundle up blood samples at the end of the week and send them to a lab, which delayed the time when clinicians could start to stage patients according to guidelines. Under that system, the median time from enrollment to HIV staging based on CD4 counts was 32 days.

That and other markers improved when the point-of-care test was used, they reported.

The findings come from analysis of records at the four clinics before and after the introduction of the new test. At each clinic, the researchers examined data for 125 patients enrolled consecutively over one month before the change and another 125 consecutive patients in a month afterward. (The time period was longer for one clinic with a low patient population.)

The primary endpoints were completed CD4 staging and initiation of anti-retroviral treatment.

All told, the researchers analyzed data for nearly 1,000 patients -- 492 before the rapid test and 437 afterward.

They found:

Before the rapid test, 57% of patients were lost to follow-up before they completed CD4 staging, compared with 21% afterward. The adjusted odds ratio was 0.2, with a 95% confidence interval from 0.15 to 0.27.

The loss to follow-up before starting therapy fell from 64% to 33%. The adjusted odds ratio was 0.27, with a 95% confidence interval from 0.21 to 0.36.

The proportion of enrolled patients who started therapy rose from 12% to 22%. The adjusted odds ratio was 2.05, with a 95% confidence interval from 1.42 to 2.96.

The median time from enrollment to starting therapy initiation fell from 48 days to 20 days (which was significant at P<0.0001), mainly because of faster CD4 staging, which fell from 32 days to three days (again significant at P<0.0001).

Loss to follow-up between staging and starting treatment did not change significantly.

Jani and colleagues noted that the study was retrospective, observational, and nonrandomized, so that "the results should be interpreted with caution."

Nevertheless, they concluded, the test appeared "to substantially improve antiretroviral therapy-related retention and access to treatment."

One possible benefit, they added, is that cutting the dropout rate might mean more patients would start therapy at a relatively high CD4 count, reducing their risk of opportunistic infections and death.

The study had support from Absolute Return for Kids and UNITAID. The authors said they had no conflicts.

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.